Abstract
PurposeUrologists have an obligation to limit radiation exposure during routine stone surgery. We therefore sought to evaluate the impact of our technique for fluoroless ureteroscopy on perioperative outcomes.MethodsMedical records of 44 patients who underwent ureteroscopy with laser lithotripsy without the use of fluoroscopy between October 2017 and December 2018 were examined. Multiple variables were collected, including age, body mass index (BMI), mean stone volume and density, operative times, complications, and stone-free rates. These patients were then compared to a cohort of 44 patients who underwent stone surgery with a conventional technique prior to the adoption of a fluoroless technique by the same surgeons. The primary study outcome was reduction of intraoperative fluoroscopy. Secondary outcomes included complications, operative time, and stone-free rates.ResultsOf the 44 patients undergoing a fluoroless technique, 38 (86.4%) were able to receive ureteroscopy without the use of fluoroscopy. A significant difference was observed in mean fluoroscopy times for the fluoroless group (2.8 seconds) and the conventional group (33.7 seconds). No complications were observed in either group. Operative length was 38.9 minutes in the fluoroless group versus 42.2 minutes in the conventional group. Age, BMI, stone characteristics, and stone-free rates were similar in both.ConclusionsThe use of a fluoroless technique for the treatment of uncomplicated stones is not only safe but also effective and efficient. This technique eliminates extraneous radiation doses to the patient and operative staff in most cases.
Highlights
Urolithiasis is currently estimated to affect 10.6% of men and 7.1% of women in the United States, with an increased lifetime risk of a symptomatic stone episode [1]
Multiple variables were collected, including age, body mass index (BMI), mean stone volume and density, operative times, complications, and stone-free rates. These patients were compared to a cohort of 44 patients who underwent stone surgery with a conventional technique prior to the adoption of a fluoroless technique by the same surgeons
A significant difference was observed in mean fluoroscopy times for the fluoroless group (2.8 seconds) and the conventional group (33.7 seconds)
Summary
Urolithiasis is currently estimated to affect 10.6% of men and 7.1% of women in the United States, with an increased lifetime risk of a symptomatic stone episode [1]. Urolithiasis often results in the need for an intervention These patients are exposed to potentially harmful doses of ionizing radiation starting at diagnosis and continuing throughout their treatment and follow-up. Fluoroscopy use during these procedures exposes the patient, operative staff, and surgeon to ionizing radiation. All forms of ionizing radiation have the potential to cause cancer, with no standard limitation for prevention [3,4,5]. This topic remains heavily debated within the medical physics community, the principles of “justification” and “optimization” applied to the use of ionizing radiation for medical purposes remain foundational among clinicians
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